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MComes RPH

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Everything posted by MComes RPH

  1. MComes RPH


    You're welcome, anytime.
  2. MComes RPH


    Otolorin, There are no known side effects of TUDCA mentioned in any of the studies I have read or the supplements I have looked at. Since it is a product that is already available in our own bodies, this doesn't surprise me. But we should always be cautious with the amount that we take, even of natural products, because we know that the more we take the greater the chance of adverse reactions or side effects. The maximum dosage per day is about 1,500mg. I would recommend starting off at a lower dosage, maybe 500mg per day, then increase it to 1,000mg per day the following week. I hope this helps and please keep me posted.
  3. MComes RPH


    Hiker, I have seen studies that have shown that this may have neuroprotective properties, I still believe more research has to be done. Also, since this is primarily used for blood pressure the untoward effects on the body may cause issues. I hope this helps and please keep me posted.
  4. MComes RPH


    Hiker, This is a newer finding and I don't see any reason why not to try it. TUDCA is a bile acid that has been known to help with the function of the liver and gallbladder. It isn't until recently that research has shown that it may also have neuroprotective properties in the brain. It does this by preventing a process that may cause cell death. The dosage that has been recommended is about 1,500mg per day. As you know my thoughts on dosing medications, start low and go slow. I would start with 500mg a day for about a week, then increase to 1,000mg a day for the next week, then lastly increase to the recommended 1,500mg per day thereafter. I am not aware of any medication interaction with this product, I would still recommend separating it from your other medications by at least an hour. I hope this helps and please keep me posted.
  5. MComes RPH

    Foot cramps

    Paul, It can be difficult for us to tell the difference between dystonia and spasms when it comes to exercise. It can be a combination of both, but since yours occurs shortly after starting exercise a supplement may help. The two main supplements that can help with cramping are potassium and magnesium. I recommend that everyone take at least a multivitamin every day but sometimes you may need to add extra supplements for specific issues. In your case you could add potassium and magnesium. To supplement extra potassium to help with cramps it is as easy as eating a banana every morning or about an hour prior to working out. Studies have shown that this is one of the most effective way to increase your potassium levels. As for the magnesium, the average daily multivitamin has about 100mg of magnesium in each tablet. If you find that this is not a sufficient amount to help with cramping then you can add magnesium tablets to your daily vitamin. The amount of magnesium you could take per day to help avoid cramping is around 400mg per day. You may want to take this with some food as it can be a little tough on the stomach. It is also very important to make sure you drink plenty of water. This can truly help our whole body work better. I hope this helps and please keep me posted.
  6. MComes RPH

    Dystonia Pain

    Noah, Botox is a great alternative for dystonia. Thanks for the information.
  7. MComes RPH

    Dystonia Pain

    Shiprakhanna, All of those items should work well for all types of pain, such as muscle, joint, or back pain. The primary thing to remember is to use it for short periods throughout the day instead of one long session. The reason for this is that cold can contact the muscles and removing the cold will expand the muscles, thus allowing muscles to move with exerting pressure on it. This is also a good alternative to try before medication therapy is started. I hope this helps and please keep me posted.
  8. MComes RPH

    Dystonia Pain

    Afroney, It sounds like the stimulator could really help you, but I am glad that the pain medication and increased Baclofen has helped. It is very important that the cdiff and sepsis are eradicated before you attempt any further procedures. I hope this helps and please keep me posted.
  9. MComes RPH

    Sinemet side effects

    Divi, You are very welcome.
  10. MComes RPH

    Transition to higher dose of CL

    Super, It does sound like your body may not be able to store up much Dopamine due to the less than restful sleep. I would absolutely advise you have the sleep test done because it could have a large impact on your quality of life. Please update me after the switch, I would appreciate it greatly.
  11. MComes RPH

    Sinemet side effects

    Divi, I'm sorry for any confusion. The dose is individualized and based on symptom relief, but there is an a dosing scale. Patients may experience these same side effects but to a lesser extent. The urine may be a lighter yellow than you are experiencing or the eye twitch might be a blink small blink issue. As one increases the dose of a medication, these side effects may be more pronounced. The urine can be different shades of darkness and the twitch can progress into an issue of low eye movements with the possibility of dry eye. I don't think that the Sinemet dose you are on is high by any means. A higher end dose could be considered around 1,500-2,000 mg, but that doesn't mean that doses cannot be higher than that. I hope this helps and please keep me posted.
  12. MComes RPH

    tinnitus from ropinirole increase?

    I'm glad I could help and if you need anything please don't hesitate to ask.
  13. MComes RPH

    Sinemet side effects

    Divi, All of these are side effects of Sinemet. The twitching of the eyes can be directly related to twitching of the head and neck that are also associated with Sinemet. The dark urine and blackened stools are also side effects of Sinemet, but unfortunately the cause is unknown. Also, these side effects can be more pronounced with an increase in the amount of Sinemet that is taken. Less Sinemet, the less the side effects I hope this helps and please keep me posted.
  14. MComes RPH

    Transition to higher dose of CL

    Super, I really appreciate the donation, it helps so many people. I would first try to have you take the Rytary first thing in the morning followed by the Azilect an hour or so later. Since the Rytary has worked well for you in the past and present, I would rather have you try this than to change to an immediate release C/L. The Rytary does have a faster onset for symptom relief than does the Azilect, this is why you should try to take it first thing in the morning. Make sure you take 30-45 minutes prior to a meal or about 60-90 minutes after meal. As you already know, this will help give you the best absorption. As far as depleting your Dopamine stores at night, this could be adding to your daily off issues. The way your body can store up Dopamine is at rest, but more importantly a a calm rest. A person can use up Dopamine when they sleep if they move around in their sleep, are constantly getting up, or have active sleep where they react to dreams/nightmares. Dopamine is used to control muscle movement and in most people they do not move much during sleep. Other people who have active "rest" may not be able to store up as much Dopamine as others. Restful sleep is important to all people but more importantly for people with PD. Many PD patients can greatly reduce their daytime off periods by being able to get a peaceful sleep. I hope this helps and please keep me posted.
  15. MComes RPH

    tinnitus from ropinirole increase?

    Diana, It sounds like you are sensitive to dosage changes by the headaches related to the increase in headaches. This could be a side effect of the increase in dosage. What I would recommend would be to increase just one dosage a day, the wait 5-7 days to increase a second dose. If you are sensitive to dosage increases this method will help your body adapt to that change. Here is what I recommend for the Ropinirole dosing: Week 1: Take 0.75mg AM, ).75mg AFTERNOON, 1.0mg BEDTIME Week 2: Take 1.0mg AM, 0.75mg AFTERNOON, 1.0mg BEDTIME Week 3: Take 1.0mg AM, 1.0mg AFTERNOON, 1.0mg BEDTIME It is a side effect that usually goes away the longer someone is taking the medication, but the above schedule will best help your body to adjust to the increase dosage while also limiting the side effects of the medication. I hope this helps and please keep me posted.
  16. Hiker, I believed that I just answered your question about staying on Ropinirole. I would continue on with the Ropinirole just with a higher dose throughout the day. If this higher dose dose not help with the gate then I would recommend that you try Amantadine with the Ropinirole instead of switching to a completely switching medication classes. Now there is an extended release Amantadine, called Gocovri, which is just taken once daily as opposed to up to 3 times a day for regular Amantadine. I hope this helps and please keep me posted.
  17. MComes RPH

    ropinirole vs levedopa

    Hiker, My suggestion would be to try an increase in Ropinirole since it has been successful for you in the past. With the maximum dose of Ropinirole is 18 mg per day, you still have room to increase your dose with greater control over your symptoms. If a medication works for you, I suggest you stick with it since it can be very difficult to find one specific medication that works so well. A change may be needed later if the Ropinirole becomes ineffective. It appears that the three times a day dosing is working for you, you may want to start with increasing your dosage at the times of the day that most need it. You may find that you need a higher dose at certain times of the day than others. By adjusting the doses throughout the day you can get better specific control during the day. Being as that your are very active, this would be my suggestion to fine tune control symptoms throughout the day. Another option may be to add an extended release Ropinirole at some point during the day. While regular Ropinirole can take care of symptoms for 4-6 hours, and extended release can take care of symptoms much longer, maybe 6-8 hours. This would be used as an overall control of symptoms, it can also be used with the regular Ropinirole to control symptoms. I hope this helps and please keep me posted.
  18. MComes RPH

    mcc950 your opinion thanks

    Maverick, I think that mcc950 is very promising but still needs more studying, either in the lab or patient trials. It has long been believed that inflammation may play a part in PD, as well as many other ailments and diseases. It isn't until recently that the inflammatory process has been studied to this extent. Mcc950 is primarily being studied in Traumatic Brain Injuries to see what effect it has on blocking NLRP3 ( a specific inflammatory inflammasone) in the brains protection after a brain injury. In studying this process, it is believed that this inflammation can have a similar effect in PD. I believe it is much too soon to put all of our eggs in that basket. We are still trying to narrow down if PD is genetic or brought on by environments factors. I believe that the research in stem cell therapy/replacement is very promising and may eventually result in a breakthrough. For now, since the actual cause as to why Dopamine cells dye has not been established, our best defense is medication therapy. We have had great advancements in medication therapy in the not so distant past and, for now more than ever, we have choices than we have ever had. I hope this helps and please keep me posted.
  19. MComes RPH


    Divi, I do agree with your Doctor on the dosing of your Sinemet. from previous conversations it sounds like you have a good handle on when your off times are. It sounds like you may not be receiving enough Sinemet to have greater control over the off periods. I have a couple of suggestions One suggestion may be to add a Sinemet CR in the early to later morning. Many people will start the day with regular Sinemet to get a jump start on covering the symptoms because the regular Sinemet can have a faster release than the CR. If Sinemet Cr is added, I would advise taking the Sinemet CR about 60-90 minutes after taking the regular Sinemet. If the regular Sinemet morning dose lasts longer than 2 hours, I would recommend taking the Sinemet Cr about 90-120 minutes after the regular Sinemet. Sinemet CR can be taken 3 times a day so you will have a little wiggle room in dosing. My second suggestion would be to increase the daily dosages of regular Sinemet. An increase of as low as 1/2 tablet can have a great impact on symptoms. As always, the dose should be started low and slowly increased to avoid any side effects. The dosage should optimally be taken about 30-45 minutes prior to off symptoms coming on. I know this may differ throughout the day, but keeping a journal may help narrow down the time range. I hope this helps and please keep me posted.
  20. MComes RPH


    Super, I 100% agree with your MDS and that is how i recommend dosing be handled. We first like to start with a standard dosing schedule, like 3 times a day, and then work towards symptom relief. Your 3 times a day may be different than someone else's, but this is a starting point that we can use as a baseline for further fine tuning of your overall dosing regime I hope this helps and please keep me posted.
  21. MComes RPH

    Decreasing Diphasic Dyskinesia

    Campt68, If you or only take 2 to 2 & 1/2 tablets a day of Sinemet. I would highly guess that you are not getting too much of a dose. If you are by chance experiencing dyskensia within an our after taking it, then that dose at that particular time might be a little high. If you are getting to large of a dose of Ropinirole, you may experience drowsiness, dizziness, nausea, and possible lightheadedness with fainting. The timing of the Ropinirole at lower doses should be based on symptom relief. It can be dosed starting at two to three times a day. I recommend taking your first dose of the day and then waiting until you start to feel symptoms coming on, then take the second dose. This should then be done with the remaining doses. Like we spoke about earlier, it is best to start low and go slow with the dosing to stay away from side effects. I hope this helps and please keep me posted.
  22. MComes RPH

    Can Rasagiline Be Stopped After Two Months

    Calliope, No matter how long a patient is taking a medication, I do not recommend that you stop taking the medication without first checking with your physician. I hope this helps and please keep me posted.
  23. MComes RPH

    Pharmacy refuses to fill prescribed generic

    Calprof, This is a little trick that very few employers tell you about. Since many of the mail order companies are set up to purchase a medication at the cheapest price possible, may times this does not work for certain medications such as Parkinson medications, blood thinners, and certain seizure medications. Thank you so much for the information and if you have any other questions, please keep me posted.
  24. MComes RPH

    Sinemet vs. Sinemet ER

    Market, There is a brand name Sinemet CR available and it comes in two different strengths, CR 25/100 and CR 50/200. I hope this helps and please keep me posted